We need to involve people in difficult decisions about services

The full involvement of those who use services at all stages of design, delivery and review – co-production – is vital if we are going to shift services away from institutional and organisational thinking.

The topic of how, where and by whom health and care services are provided, can be sensitive. Each organisation has a vested interest in staying in business, and no one wants to appear to be reducing their own services. So for example, the NHS sometimes uses phrases like 'reconfiguration' and 'hospital decentralisation', when it in reality we are talking about reducing the number of hospital beds, and even the number of hospitals.

This is not to suggest that all of these changes are bad. The reduction, for instance, in long-stay hospitals for people with learning disabilities is by-and-large welcomed. The Five Year Forward View, the plan for health reform, with its focus on delivering more care nearer to people's homes, represents a shift away from reliance on hospitals. And we can expect more of this to come. Analysis by the Kings Fund of Sustainability and Transformation Plans (STPs) predicts large reductions to hospital capacity: “STPs could lead to cuts in the number of acute hospitals in some areas, as well as reductions in the number of beds in acute and community hospitals.”

Changes on this scale have major implications for communities. Hospital closures, as with any changes to core public services, can be upsetting for those who use them. Even if the changes will be beneficial over the longer term, we shouldn't expect people to believe this to be true. And, we must remember, many people who rely on services have often been ignored or perhaps consulted half-heartedly in the past. 

We need a different way. People who use health and care services, and their families, know an awful lot about those services - the good and the bad bits. They often understand long in advance of professionals what needs to change. Plans for changes to where and how services are provided need to be developed with the people who use them. And then it’s crucial that they are central to the delivery and evaluation of the services that emerge. 

So, this is not always about getting people’s backing for change. People might disagree with the plans. But involving them in developing, delivering and evaluating the plans, from the outset, can only enhance them. Yes, there may be very difficult conversations to be had as part of this, and some people will remain critical about the changes, but in the long run, using co-production, we should arrive at better, more acceptable plans. 

As the charity National Voices have said: “Properly embraced, the insight, experience and expertise of citizens can make services better tailored, more sustainable, and ensure that service changes command legitimacy. Services should engage with, involve, and empower patients, carers and the public.”

The same arguments apply when local statutory organisations are taking tough decisions about services. Co-production has to be at the heart of any changes which affect those who use services, their carers and communities more widely.